Provider Demographics
NPI:1558831768
Name:TADDEI, LISA RUTH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RUTH
Last Name:TADDEI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6089 YONA CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-7446
Mailing Address - Country:US
Mailing Address - Phone:301-524-5319
Mailing Address - Fax:
Practice Address - Street 1:6600 S TROTTER RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1248
Practice Address - Country:US
Practice Address - Phone:410-313-7142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02666235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist